General Anesthesia Versus Conscious Sedation and Local Anesthesia during Thrombectomy for Acute Ischemic Stroke

M. Cappellari; G. Pracucci; S. Forlivesi; V. Saia; S. Nappini; P. Nencini; D. Inzitari; L. Greco; F. Sallustio; S. Vallone; G. Bigliardi; A. Zini; A. Pitrone; F. Grillo; R. Musolino; S. Bracco; R. Tinturini; R. Tassi; M. Bergui; P. Cerrato; A. Saletti; A. De Vito; I. Casetta; R. Gasparotti; M. Magoni; L. Castellan; L. Malfatto; R. Menozzi; U. Scoditti; F. Causin; C. Baracchini; E. Puglielli; A. Casalena; M. Ruggiero; E. Malatesta; C. Comelli; G. Chianale; D.L. Lauretti; M. Mancuso; E. Lafe; A. Cavallini; N. Cavasin; A. Critelli; E.F.M. Ciceri; B. Bonetti; L. Chiumarulo; M. Petruzzelli; A. Giorgianni; M. Versino; M.P. Ganimede; A. Tinelli; W. Auteri; A. Petrone; G. Guidetti; E. Nicolini; L. Allegretti; T. Tassinari; P. Filauri; S. Sacco; M. Pavia; P. Invernizzi; N.P. Nuzzi; M. Carmela Spinelli; P. Amistà; M. Russo; D. Ferrandi; S. Corraine; G. Craparo; M. Mannino; L. Simonetti; D. Toni; S. Mangiafico

doi:10.1161/STROKEAHA.120.028963

General Anesthesia Versus Conscious Sedation and Local Anesthesia during Thrombectomy for Acute Ischemic Stroke

M. Cappellari, G. Pracucci, S. Forlivesi, V. Saia, S. Nappini, P. Nencini, D. Inzitari, L. Greco, F. Sallustio, S. Vallone, G. Bigliardi, A. Zini, A. Pitrone, F. Grillo, R. Musolino, S. Bracco, R. Tinturini, R. Tassi, M. Bergui, P. CerratoA. Saletti, A. De Vito, I. Casetta, R. Gasparotti, M. Magoni, L. Castellan, L. Malfatto, R. Menozzi, U. Scoditti, F. Causin, C. Baracchini, E. Puglielli, A. Casalena, M. Ruggiero, E. Malatesta, C. Comelli, G. Chianale, D.L. Lauretti, M. Mancuso, E. Lafe, A. Cavallini, N. Cavasin, A. Critelli, E.F.M. Ciceri, B. Bonetti, L. Chiumarulo, M. Petruzzelli, A. Giorgianni, M. Versino, M.P. Ganimede, A. Tinelli, W. Auteri, A. Petrone, G. Guidetti, E. Nicolini, L. Allegretti, T. Tassinari, P. Filauri, S. Sacco, M. Pavia, P. Invernizzi, N.P. Nuzzi, M. Carmela Spinelli, P. Amistà, M. Russo, D. Ferrandi, S. Corraine, G. Craparo, M. Mannino, L. Simonetti, D. Toni, S. Mangiafico

Istituto Scienze Neurologiche

Research output: Contribution to journal › Article › peer-review

Abstract

Background and Purpose: As numerous questions remain about the best anesthetic strategy during thrombectomy, we assessed functional and radiological outcomes in stroke patients treated with thrombectomy in presence of general anesthesia (GA) versus conscious sedation (CS) and local anesthesia (LA). Methods: We conducted a cohort study on prospectively collected data from 4429 patients enrolled in the Italian Registry of Endovascular Treatment in Acute Stroke. Results: GA was used in 2013 patients, CS in 1285 patients, and LA in 1131 patients. The rates of 3-month modified Rankin Scale score of 0-1 were 32.7%, 33.7%, and 38.1% in the GA, CS, and LA groups: GA versus CS: odds ratios after adjustment for unbalanced variables (adjusted odds ratio [aOR]), 0.811 (95% CI, 0.602-1.091); and GA versus LA: aOR, 0.714 (95% CI, 0.515-0.990). The rates of modified Rankin Scale score of 0-2 were 42.5%, 46.6%, and 52.4% in the GA, CS, and LA groups: GA versus CS: aOR, 0.902 (95% CI, 0.689-1.180); and GA versus LA: aOR, 0.769 (95% CI, 0.566-0.998). The rates of 3-month death were 21.5%, 19.7%, and 14.8% in the GA, CS, and LA groups: GA versus CS: aOR, 0.872 (95% CI, 0.644-1.181); and GA versus LA: aOR, 1.235 (95% CI, 0.844-1.807). The rates of parenchymal hematoma were 9%, 12.6%, and 11.3% in the GA, CS, and LA groups: GA versus CS: aOR, 0.380 (95% CI, 0.262-0.551); and GA versus LA: aOR, 0.532 (95% CI, 0.337-0.838). After model of adjustment for predefined variables (age, sex, thrombolysis, National Institutes of Health Stroke Scale, onset-to-groin time, anterior large vessel occlusion, procedure time, prestroke modified Rankin Scale score of

Original language	English
Pages (from-to)	2036-2044
Number of pages	9
Journal	Stroke
DOIs	https://doi.org/10.1161/STROKEAHA.120.028963
Publication status	Published - 2020

Keywords

anesthesia
conscious sedation
groin
odds ratio
thrombectomy
adverse event
aged
brain ischemia
cerebrovascular accident
endovascular surgery
female
general anesthesia
human
ischemia
male
middle aged
procedures
register
very elderly
Aged
Aged, 80 and over
Anesthesia, General
Brain Ischemia
Endovascular Procedures
Female
Humans
Ischemia
Male
Middle Aged
Registries
Stroke
Thrombectomy

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10.1161/STROKEAHA.120.028963

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Cappellari, M., Pracucci, G., Forlivesi, S., Saia, V., Nappini, S., Nencini, P., Inzitari, D., Greco, L., Sallustio, F., Vallone, S., Bigliardi, G., Zini, A., Pitrone, A., Grillo, F., Musolino, R., Bracco, S., Tinturini, R., Tassi, R., Bergui, M., ... Mangiafico, S. (2020). General Anesthesia Versus Conscious Sedation and Local Anesthesia during Thrombectomy for Acute Ischemic Stroke. Stroke, 2036-2044. https://doi.org/10.1161/STROKEAHA.120.028963

General Anesthesia Versus Conscious Sedation and Local Anesthesia during Thrombectomy for Acute Ischemic Stroke. / Cappellari, M.; Pracucci, G.; Forlivesi, S.; Saia, V.; Nappini, S.; Nencini, P.; Inzitari, D.; Greco, L.; Sallustio, F.; Vallone, S.; Bigliardi, G.; Zini, A.; Pitrone, A.; Grillo, F.; Musolino, R.; Bracco, S.; Tinturini, R.; Tassi, R.; Bergui, M.; Cerrato, P.; Saletti, A.; De Vito, A.; Casetta, I.; Gasparotti, R.; Magoni, M.; Castellan, L.; Malfatto, L.; Menozzi, R.; Scoditti, U.; Causin, F.; Baracchini, C.; Puglielli, E.; Casalena, A.; Ruggiero, M.; Malatesta, E.; Comelli, C.; Chianale, G.; Lauretti, D.L.; Mancuso, M.; Lafe, E.; Cavallini, A.; Cavasin, N.; Critelli, A.; Ciceri, E.F.M.; Bonetti, B.; Chiumarulo, L.; Petruzzelli, M.; Giorgianni, A.; Versino, M.; Ganimede, M.P.; Tinelli, A.; Auteri, W.; Petrone, A.; Guidetti, G.; Nicolini, E.; Allegretti, L.; Tassinari, T.; Filauri, P.; Sacco, S.; Pavia, M.; Invernizzi, P.; Nuzzi, N.P.; Carmela Spinelli, M.; Amistà, P.; Russo, M.; Ferrandi, D.; Corraine, S.; Craparo, G.; Mannino, M.; Simonetti, L.; Toni, D.; Mangiafico, S.

In: Stroke, 2020, p. 2036-2044.

Research output: Contribution to journal › Article › peer-review

Cappellari, M, Pracucci, G, Forlivesi, S, Saia, V, Nappini, S, Nencini, P, Inzitari, D, Greco, L, Sallustio, F, Vallone, S, Bigliardi, G, Zini, A, Pitrone, A, Grillo, F, Musolino, R, Bracco, S, Tinturini, R, Tassi, R, Bergui, M, Cerrato, P, Saletti, A, De Vito, A, Casetta, I, Gasparotti, R, Magoni, M, Castellan, L, Malfatto, L, Menozzi, R, Scoditti, U, Causin, F, Baracchini, C, Puglielli, E, Casalena, A, Ruggiero, M, Malatesta, E, Comelli, C, Chianale, G, Lauretti, DL, Mancuso, M, Lafe, E, Cavallini, A, Cavasin, N, Critelli, A, Ciceri, EFM, Bonetti, B, Chiumarulo, L, Petruzzelli, M, Giorgianni, A, Versino, M, Ganimede, MP, Tinelli, A, Auteri, W, Petrone, A, Guidetti, G, Nicolini, E, Allegretti, L, Tassinari, T, Filauri, P, Sacco, S, Pavia, M, Invernizzi, P, Nuzzi, NP, Carmela Spinelli, M, Amistà, P, Russo, M, Ferrandi, D, Corraine, S, Craparo, G, Mannino, M, Simonetti, L, Toni, D & Mangiafico, S 2020, 'General Anesthesia Versus Conscious Sedation and Local Anesthesia during Thrombectomy for Acute Ischemic Stroke', Stroke, pp. 2036-2044. https://doi.org/10.1161/STROKEAHA.120.028963

Cappellari, M. ; Pracucci, G. ; Forlivesi, S. ; Saia, V. ; Nappini, S. ; Nencini, P. ; Inzitari, D. ; Greco, L. ; Sallustio, F. ; Vallone, S. ; Bigliardi, G. ; Zini, A. ; Pitrone, A. ; Grillo, F. ; Musolino, R. ; Bracco, S. ; Tinturini, R. ; Tassi, R. ; Bergui, M. ; Cerrato, P. ; Saletti, A. ; De Vito, A. ; Casetta, I. ; Gasparotti, R. ; Magoni, M. ; Castellan, L. ; Malfatto, L. ; Menozzi, R. ; Scoditti, U. ; Causin, F. ; Baracchini, C. ; Puglielli, E. ; Casalena, A. ; Ruggiero, M. ; Malatesta, E. ; Comelli, C. ; Chianale, G. ; Lauretti, D.L. ; Mancuso, M. ; Lafe, E. ; Cavallini, A. ; Cavasin, N. ; Critelli, A. ; Ciceri, E.F.M. ; Bonetti, B. ; Chiumarulo, L. ; Petruzzelli, M. ; Giorgianni, A. ; Versino, M. ; Ganimede, M.P. ; Tinelli, A. ; Auteri, W. ; Petrone, A. ; Guidetti, G. ; Nicolini, E. ; Allegretti, L. ; Tassinari, T. ; Filauri, P. ; Sacco, S. ; Pavia, M. ; Invernizzi, P. ; Nuzzi, N.P. ; Carmela Spinelli, M. ; Amistà, P. ; Russo, M. ; Ferrandi, D. ; Corraine, S. ; Craparo, G. ; Mannino, M. ; Simonetti, L. ; Toni, D. ; Mangiafico, S. / General Anesthesia Versus Conscious Sedation and Local Anesthesia during Thrombectomy for Acute Ischemic Stroke. In: Stroke. 2020 ; pp. 2036-2044.

@article{37946f0a1e6246d6b627062fb6884738,

title = "General Anesthesia Versus Conscious Sedation and Local Anesthesia during Thrombectomy for Acute Ischemic Stroke",

abstract = "Background and Purpose: As numerous questions remain about the best anesthetic strategy during thrombectomy, we assessed functional and radiological outcomes in stroke patients treated with thrombectomy in presence of general anesthesia (GA) versus conscious sedation (CS) and local anesthesia (LA). Methods: We conducted a cohort study on prospectively collected data from 4429 patients enrolled in the Italian Registry of Endovascular Treatment in Acute Stroke. Results: GA was used in 2013 patients, CS in 1285 patients, and LA in 1131 patients. The rates of 3-month modified Rankin Scale score of 0-1 were 32.7%, 33.7%, and 38.1% in the GA, CS, and LA groups: GA versus CS: odds ratios after adjustment for unbalanced variables (adjusted odds ratio [aOR]), 0.811 (95% CI, 0.602-1.091); and GA versus LA: aOR, 0.714 (95% CI, 0.515-0.990). The rates of modified Rankin Scale score of 0-2 were 42.5%, 46.6%, and 52.4% in the GA, CS, and LA groups: GA versus CS: aOR, 0.902 (95% CI, 0.689-1.180); and GA versus LA: aOR, 0.769 (95% CI, 0.566-0.998). The rates of 3-month death were 21.5%, 19.7%, and 14.8% in the GA, CS, and LA groups: GA versus CS: aOR, 0.872 (95% CI, 0.644-1.181); and GA versus LA: aOR, 1.235 (95% CI, 0.844-1.807). The rates of parenchymal hematoma were 9%, 12.6%, and 11.3% in the GA, CS, and LA groups: GA versus CS: aOR, 0.380 (95% CI, 0.262-0.551); and GA versus LA: aOR, 0.532 (95% CI, 0.337-0.838). After model of adjustment for predefined variables (age, sex, thrombolysis, National Institutes of Health Stroke Scale, onset-to-groin time, anterior large vessel occlusion, procedure time, prestroke modified Rankin Scale score of ",

keywords = "anesthesia, conscious sedation, groin, odds ratio, thrombectomy, adverse event, aged, brain ischemia, cerebrovascular accident, endovascular surgery, female, general anesthesia, human, ischemia, male, middle aged, procedures, register, very elderly, Aged, Aged, 80 and over, Anesthesia, General, Brain Ischemia, Endovascular Procedures, Female, Humans, Ischemia, Male, Middle Aged, Registries, Stroke, Thrombectomy",

author = "M. Cappellari and G. Pracucci and S. Forlivesi and V. Saia and S. Nappini and P. Nencini and D. Inzitari and L. Greco and F. Sallustio and S. Vallone and G. Bigliardi and A. Zini and A. Pitrone and F. Grillo and R. Musolino and S. Bracco and R. Tinturini and R. Tassi and M. Bergui and P. Cerrato and A. Saletti and {De Vito}, A. and I. Casetta and R. Gasparotti and M. Magoni and L. Castellan and L. Malfatto and R. Menozzi and U. Scoditti and F. Causin and C. Baracchini and E. Puglielli and A. Casalena and M. Ruggiero and E. Malatesta and C. Comelli and G. Chianale and D.L. Lauretti and M. Mancuso and E. Lafe and A. Cavallini and N. Cavasin and A. Critelli and E.F.M. Ciceri and B. Bonetti and L. Chiumarulo and M. Petruzzelli and A. Giorgianni and M. Versino and M.P. Ganimede and A. Tinelli and W. Auteri and A. Petrone and G. Guidetti and E. Nicolini and L. Allegretti and T. Tassinari and P. Filauri and S. Sacco and M. Pavia and P. Invernizzi and N.P. Nuzzi and {Carmela Spinelli}, M. and P. Amist{\`a} and M. Russo and D. Ferrandi and S. Corraine and G. Craparo and M. Mannino and L. Simonetti and D. Toni and S. Mangiafico",

year = "2020",

doi = "10.1161/STROKEAHA.120.028963",

language = "English",

pages = "2036--2044",

journal = "Stroke",

issn = "0039-2499",

publisher = "Lippincott Williams and Wilkins",

}

TY - JOUR

T1 - General Anesthesia Versus Conscious Sedation and Local Anesthesia during Thrombectomy for Acute Ischemic Stroke

AU - Cappellari, M.

AU - Pracucci, G.

AU - Forlivesi, S.

AU - Saia, V.

AU - Nappini, S.

AU - Nencini, P.

AU - Inzitari, D.

AU - Greco, L.

AU - Sallustio, F.

AU - Vallone, S.

AU - Bigliardi, G.

AU - Zini, A.

AU - Pitrone, A.

AU - Grillo, F.

AU - Musolino, R.

AU - Bracco, S.

AU - Tinturini, R.

AU - Tassi, R.

AU - Bergui, M.

AU - Cerrato, P.

AU - Saletti, A.

AU - De Vito, A.

AU - Casetta, I.

AU - Gasparotti, R.

AU - Magoni, M.

AU - Castellan, L.

AU - Malfatto, L.

AU - Menozzi, R.

AU - Scoditti, U.

AU - Causin, F.

AU - Baracchini, C.

AU - Puglielli, E.

AU - Casalena, A.

AU - Ruggiero, M.

AU - Malatesta, E.

AU - Comelli, C.

AU - Chianale, G.

AU - Lauretti, D.L.

AU - Mancuso, M.

AU - Lafe, E.

AU - Cavallini, A.

AU - Cavasin, N.

AU - Critelli, A.

AU - Ciceri, E.F.M.

AU - Bonetti, B.

AU - Chiumarulo, L.

AU - Petruzzelli, M.

AU - Giorgianni, A.

AU - Versino, M.

AU - Ganimede, M.P.

AU - Tinelli, A.

AU - Auteri, W.

AU - Petrone, A.

AU - Guidetti, G.

AU - Nicolini, E.

AU - Allegretti, L.

AU - Tassinari, T.

AU - Filauri, P.

AU - Sacco, S.

AU - Pavia, M.

AU - Invernizzi, P.

AU - Nuzzi, N.P.

AU - Carmela Spinelli, M.

AU - Amistà, P.

AU - Russo, M.

AU - Ferrandi, D.

AU - Corraine, S.

AU - Craparo, G.

AU - Mannino, M.

AU - Simonetti, L.

AU - Toni, D.

AU - Mangiafico, S.

PY - 2020

Y1 - 2020

N2 - Background and Purpose: As numerous questions remain about the best anesthetic strategy during thrombectomy, we assessed functional and radiological outcomes in stroke patients treated with thrombectomy in presence of general anesthesia (GA) versus conscious sedation (CS) and local anesthesia (LA). Methods: We conducted a cohort study on prospectively collected data from 4429 patients enrolled in the Italian Registry of Endovascular Treatment in Acute Stroke. Results: GA was used in 2013 patients, CS in 1285 patients, and LA in 1131 patients. The rates of 3-month modified Rankin Scale score of 0-1 were 32.7%, 33.7%, and 38.1% in the GA, CS, and LA groups: GA versus CS: odds ratios after adjustment for unbalanced variables (adjusted odds ratio [aOR]), 0.811 (95% CI, 0.602-1.091); and GA versus LA: aOR, 0.714 (95% CI, 0.515-0.990). The rates of modified Rankin Scale score of 0-2 were 42.5%, 46.6%, and 52.4% in the GA, CS, and LA groups: GA versus CS: aOR, 0.902 (95% CI, 0.689-1.180); and GA versus LA: aOR, 0.769 (95% CI, 0.566-0.998). The rates of 3-month death were 21.5%, 19.7%, and 14.8% in the GA, CS, and LA groups: GA versus CS: aOR, 0.872 (95% CI, 0.644-1.181); and GA versus LA: aOR, 1.235 (95% CI, 0.844-1.807). The rates of parenchymal hematoma were 9%, 12.6%, and 11.3% in the GA, CS, and LA groups: GA versus CS: aOR, 0.380 (95% CI, 0.262-0.551); and GA versus LA: aOR, 0.532 (95% CI, 0.337-0.838). After model of adjustment for predefined variables (age, sex, thrombolysis, National Institutes of Health Stroke Scale, onset-to-groin time, anterior large vessel occlusion, procedure time, prestroke modified Rankin Scale score of

AB - Background and Purpose: As numerous questions remain about the best anesthetic strategy during thrombectomy, we assessed functional and radiological outcomes in stroke patients treated with thrombectomy in presence of general anesthesia (GA) versus conscious sedation (CS) and local anesthesia (LA). Methods: We conducted a cohort study on prospectively collected data from 4429 patients enrolled in the Italian Registry of Endovascular Treatment in Acute Stroke. Results: GA was used in 2013 patients, CS in 1285 patients, and LA in 1131 patients. The rates of 3-month modified Rankin Scale score of 0-1 were 32.7%, 33.7%, and 38.1% in the GA, CS, and LA groups: GA versus CS: odds ratios after adjustment for unbalanced variables (adjusted odds ratio [aOR]), 0.811 (95% CI, 0.602-1.091); and GA versus LA: aOR, 0.714 (95% CI, 0.515-0.990). The rates of modified Rankin Scale score of 0-2 were 42.5%, 46.6%, and 52.4% in the GA, CS, and LA groups: GA versus CS: aOR, 0.902 (95% CI, 0.689-1.180); and GA versus LA: aOR, 0.769 (95% CI, 0.566-0.998). The rates of 3-month death were 21.5%, 19.7%, and 14.8% in the GA, CS, and LA groups: GA versus CS: aOR, 0.872 (95% CI, 0.644-1.181); and GA versus LA: aOR, 1.235 (95% CI, 0.844-1.807). The rates of parenchymal hematoma were 9%, 12.6%, and 11.3% in the GA, CS, and LA groups: GA versus CS: aOR, 0.380 (95% CI, 0.262-0.551); and GA versus LA: aOR, 0.532 (95% CI, 0.337-0.838). After model of adjustment for predefined variables (age, sex, thrombolysis, National Institutes of Health Stroke Scale, onset-to-groin time, anterior large vessel occlusion, procedure time, prestroke modified Rankin Scale score of

KW - anesthesia

KW - conscious sedation

KW - groin

KW - odds ratio

KW - thrombectomy

KW - adverse event

KW - aged

KW - brain ischemia

KW - cerebrovascular accident

KW - endovascular surgery

KW - female

KW - general anesthesia

KW - human

KW - ischemia

KW - male

KW - middle aged

KW - procedures

KW - register

KW - very elderly

KW - Aged

KW - Aged, 80 and over

KW - Anesthesia, General

KW - Brain Ischemia

KW - Endovascular Procedures

KW - Female

KW - Humans

KW - Ischemia

KW - Male

KW - Middle Aged

KW - Registries

KW - Stroke

KW - Thrombectomy

U2 - 10.1161/STROKEAHA.120.028963

DO - 10.1161/STROKEAHA.120.028963

M3 - Article

SP - 2036

EP - 2044

JO - Stroke

JF - Stroke

SN - 0039-2499

ER -